本文選題：剖宮產(chǎn)瘢痕妊娠 + 高強(qiáng)度聚焦超聲　； 參考：《南昌大學(xué)》2014年碩士論文

【摘要】：目的： 觀察剖宮產(chǎn)瘢痕妊娠(cesarean scar pregnancy，CSP)使用高強(qiáng)度聚焦超聲(high intensity focused ultrasound，HIFU)治療的臨床療效，為CSP提供更安全、有效的治療方法。 方法： 回顧性分析2008年1月至2012年12月收治的220例CSP患者的臨床資料。分為三組：藥物組給予甲氨蝶呤或米非司酮藥物治療48例；介入組行雙側(cè)子宮動(dòng)脈栓塞術(shù)（uterine artery embolization，UAE）治療142例；HIFU組均為自愿接受HIFU治療患者30例，，三組均聯(lián)合刮宮術(shù)。對(duì)所有患者進(jìn)行隨訪。比較三組有效率、β-HCG恢復(fù)時(shí)間、平均住院天數(shù)、平均費(fèi)用、刮宮術(shù)中陰道出血量，以及對(duì)HIFU組在降低血β-HCG值及病灶周邊血管阻力指數(shù)（resistance index，RI）的作用等進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 三種治療方法治療有效率上無(wú)顯著性差異(P㧐0.05)，治療后血β-HCG降至正常水平時(shí)間、平均住院天數(shù)、平均治療費(fèi)用、刮宮術(shù)中陰道出血量有顯著差異(P㩳0.05)：其中藥物組血β-HCG值降至正常水平時(shí)間較長(zhǎng)、平均費(fèi)用最少、平均住院時(shí)間最長(zhǎng)、刮宮術(shù)中陰道出血量最多；介入組血β-HCG值降至正常水平時(shí)間最短、平均費(fèi)用最高、平均住院時(shí)間較長(zhǎng)、刮宮術(shù)中陰道出血量較多；HIFU組血β-HCG降至正常水平時(shí)間最長(zhǎng)、平均費(fèi)用較少、平均住院時(shí)間最短、刮宮術(shù)中陰道出血量最少。 HIFU組在治療后1周、4周與治療前血β-HCG值相比較，差異有統(tǒng)計(jì)學(xué)意義（P0.05），HIFU治療CSP對(duì)妊娠囊具有殺滅作用，降低血β-HCG值。HIFU組在治療后1周、4周與治療前的RI值相比較，差異有統(tǒng)計(jì)學(xué)意義（P0.05），HIFU可以使CSP病灶區(qū)域的微血管產(chǎn)生損傷閉塞作用，使血流減少或消失。 結(jié)論： 1、三種治療方法中HIFU治療CSP具有費(fèi)用較低、住院時(shí)間短的特點(diǎn)。 2、三種治療方法中HIFU治療CSP具有出血少的特點(diǎn)。 3、三種治療方法中HIFU治療CSP具有損傷小、安全性高的特點(diǎn)。 4、HIFU是臨床治療CSP的一種有效、安全的新方法。
[Abstract]:Objective: To observe the clinical effect of high intensity focused ultrasound (HIFU) on cesarean scar pregnancyn (CSP) in the treatment of cesarean scar pregnancy, and to provide a more safe and effective treatment method for CSP. Methods: The clinical data of 220 patients with CSP from January 2008 to December 2012 were retrospectively analyzed. They were divided into three groups: the drug group (n = 48) received methotrexate or mifepristone (n = 48) and the interventional group (n = 142) underwent bilateral uterine artery embolization (artery). All patients were followed up. The effective rate, the recovery time of 尾 -HCG, the average hospitalization days, the average cost, the amount of vaginal bleeding during curettage, and the effect of HIFU group on reducing the blood 尾 -HCG value and the vascular resistance index around the lesion were analyzed statistically. Results: There was no significant difference in the effective rate of the three treatment methods. After treatment, the blood 尾 -HCG decreased to normal level, the average hospitalization time, the average treatment cost. There was significant difference in vaginal bleeding during curettage. The blood 尾 -HCG value of drug group decreased to the normal level for a long time, the average cost was the least, the average hospitalization time was the longest, and the vaginal bleeding volume during curettage was the most. In the intervention group, the blood 尾 -HCG value decreased to the normal level for the shortest time, the average cost was the highest, and the average hospitalization time was longer. In the HIFU group, the blood 尾 -HCG decreased to the normal level for the longest time, the average cost was less, and the average hospitalization time was the shortest. The volume of vaginal bleeding during curettage was the least. The serum 尾 -HCG value in HIFU group was significantly higher than that in pre-treatment group at 1 week and 4 weeks after treatment. There was a significant difference between P0.05HIFU group and pre-treatment group. The serum 尾 -HCG value was decreased in the HIFU group at 1 week and 4 weeks after treatment, and the RI value before treatment was compared with that in the control group at 1 week and 4 weeks after treatment, and the serum 尾 -HCG value was decreased in the HIFU group at 1 week and 4 weeks after treatment. The difference was statistically significant (P 0.05). HIFU could injure or obliterate the microvessels in the CSP lesion area and decrease or disappear the blood flow. Conclusion: Among the three treatment methods, HIFU has the characteristics of low cost and short hospital stay. Among the three treatment methods, HIFU has the characteristics of less bleeding in the treatment of CSP. Among the three treatment methods, HIFU has the characteristics of low injury and high safety in the treatment of CSP. HIFU is an effective and safe method for the treatment of CSP.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.22;R445.1

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